As reported by Loeser 13 and Jensen and Rasmussen, 10 much of this ambiguity stems from investigators not carefully distinguishing residual limb pain from phantom limb pain. 13 Unfortunately, the literature is unclear regarding the prevalence of residual limb pain once the amputation has healed. Residual limb pain is ubiquitous immediately after amputation but generally is thought to subside significantly in a few weeks coincidental with surgical healing. 18 Despite these rate variances, it commonly is thought that most persons who undergo limb amputations, possibly as many as 85%, will experience phantom limb pain. 2,9,17,18 Differences in prevalence rates seem related largely to systematic variations in study methodology, with many of the studies basing their findings on the proportion of patients seen in a medical practice for pain. Phantom limb pain has been reported to be more common than residual limb pain, 2,8,13 with reported rates of prevalence ranging from 0.5% to 100%. 2 Much less attention has been directed to understanding nonpainful phantom sensations, back pain, and the distinct qualities of intensity, frequency, and bothersomeness that constitute the dimensions of pain. Phantom limb pain has been defined as painful sensations perceived in the missing body part, 2 whereas residual limb pain is pain perceived as emanating from the residual portion of the limb (the stump). 15,17 The literature on pain after amputation primarily has focused on phantom limb pain and residual limb pain (also referred to as stump pain). Pain after limb amputation is a common sequelae that often becomes chronic, limiting quality of life and functional capacity. They also suggest that back pain after lower extremity amputation may be an overlooked but very important pain problem warranting additional clinical attention and study. These results support the importance of looking at pain as a multidimensional rather than a unidimensional construct. Back pain was significantly more common in persons with above knee amputations. Back pain surprisingly was rated as more bothersome than phantom limb pain or residual limb pain. Residual limb pain and back pain were also common after amputation. Statistical analyses revealed that nonpainful phantom limb sensations were common and more frequent than phantom limb pain. A survey of medication use for each category of sensations also was included. Using a visual analog scale, participants reported the frequency, intensity, and bothersomeness of phantom limb, residual limb, and back pain and nonpainful phantom limb sensations. Participants (n = 92) were recruited from two hospitals to complete the Prosthesis Evaluation Questionnaire which included questions about amputation related sensations and pain.
This study describes the sensations and pain reported by persons with unilateral lower extremity amputations.
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